Effectiveness of a citywide patient immunization navigator program on improving adolescent immunizations and preventive care visit rates.

OBJECTIVE To assess the impact of a tiered patient immunization navigator intervention (immunization tracking, reminder/recall, and outreach) on improving immunization and preventive care visit rates in urban adolescents. DESIGN Randomized clinical trial allocating adolescents (aged 11-15 years) to intervention vs standard of care control. SETTING Eight primary care practices. PARTICIPANTS Population-based sample of adolescents (N = 7546). INTERVENTION Immunization navigators at each practice implemented a tiered protocol: immunization tracking, telephone or mail reminder/recall, and home visits if participants remained unimmunized or behind on preventive care visits. MAIN OUTCOME MEASURES Immunization rates at study end. Secondary outcomes were preventive care visit rates during the previous 12 months and costs. RESULTS The intervention and control groups were similar at baseline for demographics (mean age, 13.5 years; 63% black, 14% white, and 23% Hispanic adolescents; and 74% receiving Medicaid), immunization rates, and preventive care visit rates. Immunization rates at the end of the study were 44.7% for the intervention group and 32.4% for the control group (adjusted risk ratio, 1.4; 95% confidence interval, 1.3-1.5); preventive care visit rates were 68.0% for the intervention group and 55.2% for the control group (1.2; 1.2-1.3). Findings were similar across practices, sexes, ages, and insurance providers. The number needed to treat for immunizations and preventive care visits was 9. The intervention cost was $3.81 per adolescent per month; the cost per additional adolescent fully vaccinated was $465, and the cost per additional adolescent receiving a preventive care visit was $417. CONCLUSION A tiered tracking, reminder/recall, and outreach intervention improved immunization and preventive care visit rates in urban adolescents. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00581347.